[Subscriber]
[Address]
[City State ZIP]
[Collector]
[Address]
[City State ZIP]
[Phone Number]
[Date]
Re
Inquiry Dated _____________: Account No. (none)
Greetings:
Thank you for your recent inquiry.
This is not a refusal to pay, but a notice that your claim is disputed.
This is a request for validation made pursuant to the Fair Debt Collection
Practices Act. Please complete the attached form and follow its instructions
and your claim will be processed as soon as this information is received.
Please be advised that I am not requesting
a "verification" that you have my mailing address, I am requesting a "validation;"
that is, competent evidence that I have some contractual obligation to
pay you.
You should also be aware that sending
unsubstantiated demands for payment through the United States Mail System
might constitute mail fraud under federaland state law. You may wish
to consult with a competent legal advisor before your next communication
with me.
Your failure to satisfy this request
within the requirements of the Fair Debt Collection Practices Act will
be construed as your absolute waiver of any and all claims against me,
and your tacit agreement to compensate me for costs and attorney fees.
Best regards,
[Debtor]
CREDITOR DISCLOSURE STATEMENT
Name and Address of Collector (Assignee):
____________________________________________________________________________
Name and Address of Debtor:
____________________________________________________________________________
Account Number(s):
____________________________________________________________________________
What are the terms of assignment
for this account? You may attach a facsimile of any records relating
to such terms.
____________________________________________________________________________
Have any insurance claims been made
by any creditor or assignee regarding this account?
Yes / no
____________________________________________________________________________
Has the purported balanced of this
account been used in any tax deduction claim?
Yes / No
____________________________________________________________________________
Please list the particular products
or services sold by the collector to the debtor and the dollar amount of
each:
____________________________________________________________________________
____________________________________________________________________________
Upon failure or refusal of collector
to validate this collection action, collector agrees to waive all claims
against the debtor named herein and pay debtor for all costs and attorney
fees involved in defending this collection action.
X________________________________
_________________
Authorized Signature for
Collector
Date
Please return this completed form
and attach all assignment or other transfer agreements that would establish
your right to collect this debt. Your claim cannot be considered
if any portion of this form is not completed and returned with the required
documents. This is a request for validation made pursuant to the
Fair Debt Collection Practices Act. If you do not respond as required
by thislaw, your claim will not be considered and you may be liable for
damages for continued collection efforts. Please allow thirty days
for processing after receipt of your request. |